重複障害児は周産期医療の発達とともに増加傾向にあるが，正確な聴力評価が困難である。また難聴の診断のみが早期に行われ，当初は難聴単独の障害として療育が開始されるが，後に広汎性発達障害（PDD）などの他の合併症が顕著になることがある。重複障害児の聴力評価は定型発達の難聴児と同様に行われるが，脳性麻痺（CP）など脳の器質的障害を伴う児では，条件詮索反応聴力検査（COR）などの行動反応聴力検査と，聴性脳幹反応（ABR）・聴性定常反応（ASSR）の結果が一致せず，聴力確定が困難な場合がある。また，合併症の医療ケアが優先されるため，補聴器（HA）装用のタイミングは個人差が大きい。PDD を伴う児では過敏性のために HA 装用や音の刺激を嫌がることがあるため，疾患の特性を理解した上で慎重に行う必要がある。重複障害児であっても補聴効果が見られない場合は重複障害の程度を総合的に判断して人工内耳を考慮するが，療育に関わる人達の理解と見解の共通性が求められる。
Disruption of vision intervention (VI) worsens global development of children with multiple disability (MD). Digital platforms help parents to continue vision intervention in pandemics. To the best ...of our knowledge, no studies have been done to assess the impact of online VI, therefore this is first. The aim is to study the impact of online VI on functional vision of children with MD during COVID-19. Fifteen children with MD recruited for in-office VI had abandoned it during the first pandemic, but had been able to continue through online during second pandemic and were recruited. Impact of online VI was retrospectively examined, by comparing functional vision (grating acuity GA and contrast sensitivity CS) at the time of discontinuance and period with online sessions. Parents received questionnaire to assess their perceptions about online VI. Discontinuity of in-office sessions during the first wave resulted in deterioration of functional vision. GA decreased from 1.5 to 0.9 cycles per degree (CPD; p = .012) and CS decreased from baseline in eight children. Upon lockdown relaxation, resumption of in-office VI showed improvement. GA improved from 0.9 to 1.7 CPD ( p = .009) and CS improved in 10 children. However, during the second wave, with institution of online sessions, GA and CS were either maintained or improved. Results from questionnaire showed high satisfaction level of online VI among parents. Although advantages of in-office VI are undeniable, functional vision outcomes and parental satisfaction encourages to combine online and in-office VI whenever necessary.
